The half-inch-thick packet arrived at her home addressed to Phil Hughes, a homeless man she had befriended when he showed up one day and offered to paint her house number on the curb for cash.

She gave him $5 and a lunch of turkey and mashed potatoes. During the next few years, she hired him for painting, yard work and other odd jobs.

Hughes has no family in the area, so when he developed a high fever and blood infection a year and a half ago and sought treatment at John Muir Medical Center in Walnut Creek, Olsen told him to give her name and address as an emergency contact.

"I didn't want him to die and not know about it," she said.

The $42,000 bill addressed to Hughes that later arrived at Olsen's home covered the three or four days he spent in the hospital.

"It was pages and pages and pages," she said. "They detail every shot they give you, every antibiotic, every aspirin.

"Phil and I were laughing about it. Here's a homeless man who doesn't have a penny to his name and he has this enormous hospital bill. How's he going to pay it?"

The humor quickly evaporated when a collection agency began hounding her with phone calls looking for Hughes. The collectors especially liked to call early Saturday mornings.

She told them Hughes did not live there, was homeless and could not afford to pay. Her pleas made no difference: The calls continued daily for a couple of weeks.

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"Finally, I got pretty nasty," she said. She threatened to go to the newspaper with the story. "Finally, they stopped."

The bills continued for several months. She gave them to Hughes when he stopped by. He tucked them into his jacket and rode off on his bicycle.

But if it is clear that a patient is homeless, Kaufman said, John Muir seeks reimbursement through a county program for indigent adults. It does not bill patients or put them through collections, she said.

Olsen remains baffled about how the case was handled.

"I'm very happy that Phil got well taken care of at John Muir and they were good to him," she said. "According to Phil, all the doctors and nurses were very kind to him."

But she questions using aggressive collection practices on someone who is living on the streets.

"Phil is so obviously an indigent person that no one would expect he would have enough money for lunch," she said, "let alone a hospital bill."